In the Mind of the Psychopath

In fiction there's been Hannibal Lecter and American Psycho. In real life, the legacy of notorious serial killer Ted Bundy still resonates. But how much can we believe of Hollywood's Tinseltown representations of psychopaths? What is it that defines psychopathic personality? Is it a distinct psychological state? And what hope for a cure?

Transcript

Natasha Mitchell: Hello there, welcome to All in the Mind, ABC Radio National's weekly excursion into the world of all things mental. Natasha Mitchell here with you once again, and with an unexpected question: do you know a psychopath? OK - how about this one: do you know that you know a psychopath?

MUSIC/FILM CLIP - Silence of the Lambs

James Blair: Most people, fed by the Hollywood idea, imagine the psychopathic individual to be very flamboyant, a highly intelligent sort of Hannibal Lecter. But that isn't the type of individual you're seeing. Most individuals that you'll see, the type of antisocial behaviour, is much more humdrum. The best sort of cinematic equivalent I could think of is two of the characters in the movie Fargo by the Cohen Brothers. They were really not particularly successful criminals, and certainly not the flamboyance of Hannibal Lecter or some of the other Hollywood prototypes.

Natasha Mitchell: The most notorious and chilling psychopath, according to pop culture, has got to be Hannibal Lecter, in the film The Silence of the Lambs. Another that comes to mind is the sick and twisted individual that is Patrick Bateman from Brett Easton Ellis' book American Psycho. These two characters share a callous disregard for others, and a cold, bewildering cleverness. They also reveal a calculating desire to harm. They're serial killers.

FLIP CLIP

Natasha Mitchell: But how much of Hollywood's representations of the world of the psychopath can we really believe? Is psychopathy, as it's called, a distinct mental illness; and what exactly is it that makes a psychopath psychopathic?

Today we're looking into the mind of the remorseless, and you'll hear from two people who have spent many hours face-to-face with psychopathic souls: Dr James Blair is one of them. He's a neuropsychologist at University College, London, and he points out that there are now well-established personality tests for psychopathic behaviour.

James Blair: Well, there's a very specific definition. You have to score over 30 out of 40 on a specific checklist, and that checklist is made up of behaviours of two main types: the sort of classic, antisocial behaviour that you think of when you think of psychopathy - doing consistent harmful acts to other individuals - and also some pronounced emotional problems, so they don't feel guilt. It's very common amongst normal murderers to feel very guilty about the people they've actually hurt, after the offence. Psychopathic individuals: you just don't care.

Natasha Mitchell: Well, Hollywood would have us believe that a psychopath is a serial killer, or certainly a criminal. I mean, how much of what Hollywood dishes out about psychopathic behaviour can we justifiably believe?

James Blair: Not a great deal. Most psychopaths wouldn't be serial killers. They're certainly not motivated to go out and kill. They may kill somebody because that person gets in the way, but there's no desire to go and hurt another human being.

Natasha Mitchell: But certainly some serial killers would be considered to be psychopathic.

James Blair: Indeed, yes, there are some, but there's nothing about psychopathy that makes you want to go out and hurt other people. Whereas most serial killers do, there's a component of their disorder which makes them actually want to go out and hurt people. So probably those serial killers have psychopathy, but they also have additional problems that are forcing them to go out and actually do those types of offence. Psychopathic individuals are not actually linked to sadism, so they don't actually enjoy inflicting pain. What you see in psychopathic individuals is crime, but on their own terms, a good reason. I mean, they'll be mugging somebody on the street in order to gain money. If you did that, I mean, if you were very poor, you've got a good reason to go out and offend, but you'd feel so bad about it afterwards, that you wouldn't want to do it again - if you could even go through it the very first time. With these individuals, they can go through it, and they don't feel so bad about it afterwards, and so consequently the next time they're looking and thinking "oh my goodness, I've got no money", it's much easier to go out and offend.

So it's not that there's anything in the disorder that pushes them, it's just that one of the stops that prevents healthy individuals from offending, isn't there in this population. That's why we imagine that there would be people out there with the emotional problems, but because they're already wealthy or because they've got other resources to call upon, they never actually show the antisocial behaviour.

Natasha Mitchell: There's a classic book about psychopathic behaviour, The Mask of Insanity by Hervey Cleckley. He describes a psychopath as an extremely intelligent person, characterised by a poverty of emotions. Do you register with this in your own research?

James Blair: The part about the impairment of emotion, yes; the part about the extremely clever person, no. The average IQ that we see in our studies is less than the healthy, normal population. There's nothing about psychopathy that's linked with intelligence.

NEWS GRAB/AM GRAB - TED BUNDY EXECUTION

Natasha Mitchell: The American serial killer Ted Bundy was given the electric chair in 1989, after confessing to the murders of at least 30 people. And though, as we've heard, not all psychopaths are criminals or serial killers, Bundy had all the ingredients.

Stuart Kinner is a forensic psychologist and researcher at the University of Queensland, and he too has been investigating the unpleasant nature of the psychopathic personality. He's speaking with David Rutledge.

Stuart Kinner: Probably the pin-up boy for psychopathic people is Ted Bundy in some respects. He's clearly a very charming guy, clearly a very remorseless guy, and clearly a very manipulative guy. He also was a serial killer, which is another thing altogether. But he's probably the first person that comes to mind for a lot of people.

David Rutledge: What about something like American Psycho - the style of the narrative there, very flat, very emotionless - and, of course, a serial killer of the most atrocious variety. But do you think that in that novel, something is being tapped into there, you know, something really definitive?

Stuart Kinner: The term 'psycho' is kind of overused and misused, and I think the example in American Psycho, that book by Brett Easton Ellis, is a perfect example. The only thing about that guy that does represent a psychopath, as we currently understand it, is that lack of emotion, that coldness, that callousness.

Patrick Bateman (American Psycho): I have all the characteristics of a human being: flesh, blood, skin, hair - but not a single clear identifiable emotion, except for greed and disgust. Something horrible is happening inside of me, and I don't know why. My nightly bloodlust has overflowed into my days. I feel lethal, on the verge of frenzy. I think my mask of sanity is about to slip.

Stuart Kinner: There are a number of things about the character in American Psycho that don't really fit with the psychopathic profile. For example, he was very calculating, and he maintained a veneer of normality that lasted beyond an initial meeting; he was able to convince everybody of his normality for a long time. What you often find with psychopaths is that after a few meetings, you start to realise that they're not all they seem to be. Underneath their veneer of charm, underneath their veneer of knowledge, they're often a very uninformed, very insincere person.

David Rutledge: Tell me about your own experience, your own research, and the nature of the psychopathic individuals you've been in contact with.

Stuart Kinner: OK, what I've been doing is going into a maximum security prison in Queensland, and doing a series of interviews with people in there. Quite often, the people who I guess would be psychopathic, they do (to put it simply) give you the creeps a little bit when you meet them. They're often the same people who try to be very charming, who try to tell you a story, and they'll fixate their eyes on you while they tell you this story, because all the while they're just checking, have they managed to convince you, have they managed to manipulate you. And I can remember a couple of individuals that I spoke to who were very much like that, they would smile and they would appear to be very out of character with what we expect of a criminal. But the more I sat and talked to them, the more I thought "there is nothing sincere being said here".

David Rutledge: And what was the nature of the charm that was being exercised on you, when you were speaking to them?

Stuart Kinner: Well, it really ranged. One guy, for example, did something as simple as offering me a Fisherman's Friend from his pocket, which is his way of beginning to develop some rapport. And I initially took that as a very friendly sign - but it's one of those things with psychopaths, it's very hard to put your finger on exactly what it is about them. It's a superficiality; there's a friendliness there, but something inside of you is saying that it's not really sincere, that they don't really mean it, and that you don't want to turn your back on them.

Natasha Mitchell: Stuart Kinner.

In the 19th century, the French psychiatrist Philippe Pinel coined the phrase 'insanity without delirium' to describe people who appeared to totally lack remorse. But it was the American psychiatrist Hervey Cleckley who really developed the idea of the psychopathic personality in his 1941 book The Mask of Insanity. "The psychopath is lacking in the ability to see that others are moved. It is as though he were colour blind to this aspect of human existence", he wrote. He described the psychopath as emotionally stunted, and hiding behind a thin veneer of normalcy, a mask of sanity.

James Blair has been trying to unravel the emotional world of the psychopathic person, to work out what makes them unique, psychologically and biologically.

James Blair: Well, we're reasonably competent now that the type of emotional problems are specific to difficulties in processing the sadness and fear, as opposed to other sorts of emotions, like pressing another person's anger or disgust. And we're also reasonably confident that it seems to be a specific brain structure is involved - it may not be the only one, but it's certainly very important - called the amygdala. It's a very small structure that lives deep in your brain, crucial for various aspects of emotional processing, and seems to be disrupted in this population.

Natasha Mitchell: Before we come to what's happening with the amygdala, give me some examples of what happens in response to sadness and fear. What's going on there, what are some of the situations that you've observed?

James Blair: A very easy type of experiment was just to look at the sweat reaction, especially your really fundamental emotional reaction when you're seeing something that is emotional to you, is that you'll start sweating. And your pupils will dilate, and your nostrils will flare, and there are various other emotional responses, but particularly you can start measuring somebody's sweat response. So if I showed you, right now, a sad face, you would immediately start sweating ever so slightly. But if you show somebody with psychopathy a sad face, they don't show that arousal response to that particular stimulus. So we know the amygdala's involved in specific types of task, and we can see whether psychopathic individuals are impaired on all of those tasks. And they do indeed seem to be.

In addition, there's some data showing that the amygdala in this population is reduced, compared to the size that it should be in a healthy individual, and also you can actually look at the response of the amygdala to particular types of emotional stimuli, and there again, you see a much reduced response of the amygdala.

Natasha Mitchell: Now, this is where the huge challenge that faces many neuropsychologists and neurobiologists arises, and that is: sure, you can make an observation about a point in the brain in response to a particular behaviour or incident, but then it's a question of cause and effect. Is it the case that people are born with a problem with the amygdala? Or does a problem with the amygdala arise in situ - in life, if you like - in response to a particular set of circumstances that makes a person more psychopathic than another?

James Blair: This is difficult to disentangle. We know that other pathologies - I mean, anxiety disorder for example, is associated with massively overactive amygdala activity, and if you treat anxiety disorder successfully, you'll see a reduction in that amygdala activity. And in many respects, psychopathy is the flipside of anxiety disorder, and so potentially we're imagining that there may be treatments that will allow us to boost that amygdala response, and so help these individuals out. But as regards whether it's a fundamental problem caused by a specific set of genetic information, or whether it was caused by a particular environmental trauma, at a specific age; that question at the moment we just have no answer for.

Natasha Mitchell: Curiously, even though you're looking at some of the biological underpinnings of psychopathic behaviour, intuitively many people would say "well, psychopathy is something that arises when people experience abuse in childhood themselves, they don't learn to relate appropriately to other people".

James Blair: Well, it has to be said most people who are abused do not show psychopathy. So there may be a link between abuse and psychopathy, but it may be that we just need to know that the abuse happened at a particular age, and we just don't know anything like that. So I would not be surprised if it was a very weak link indeed.

Natasha Mitchell: James Blair.

Stuart Kinner is interested in an evolutionary model of psychopathy, a sort of disturbing explanation that says psychopaths exist because they're well-adapted to our society. This means that you don't have to be a criminal to be a psychopath - but does it also mean that your boss, your neighbour, even you, could be a psychopath? He's speaking again to David Rutledge.

Stuart Kinner: There have been some studies showing that for every psychopath we have in the prison, we have probably one out in the community as well. For example, there's some recent research showing that psychopaths are extremely successful in modern large corporations. Because the normal structures of these corporations are disintegrated, it's very easy for somebody who's superficially charming, remorseless, manipulative to move up in the corporate structure.

David Rutledge: You've been writing about an evolutionary model of psychopathy, and the rather worrying notion that psychopathy may constitute a "successful life strategy". Successful in what way? You've mentioned the corporation; what other kinds of benefits can psychopathy bring you?

Stuart Kinner: From that broader evolutionary perspective, a successful life strategy really means that the psychopath is passing on his genes. There's a lot of research in the last 5 to 10 years, showing that psychopaths have a much more coercive much more aggressive sexual strategy, and they're also much more promiscuous and start having sex earlier in life.

David Rutledge: And of course, if they're passing on their genes, then it could follow that they're increasing the percentage of psychopaths in the general population - if we accept that there is a genetic predisposition to psychopathy. Is that something that worries you?

Stuart Kinner: That's a good point. There was actually a fabulous article in Playboy, believe it or not, called "The Coming of the Psychopath", quite a while ago now, saying that very thing: maybe it is becoming a successful strategy, and eventually we'll all be psychopaths. Fortunately, that's not the case. It's what's called an "evolutionally stable" strategy. Psychopathy can only be successful as a life strategy when the potential victims greatly outnumber the psychopaths.

David Rutledge: Right.

Stuart Kinner: When you think about it, it's very hard for a psychopath to con another psychopath. A psychopath won't trust someone else, so we have to have a lot more victims than psychopaths out there, for them to be successful. This is why they tend to be relatively nomadic, why they tend to move from city to city and from community to community.

David Rutledge: This predatory metaphor that we're dealing with would suggest that psychopaths are usually men; is that the case?

Stuart Kinner: Yes, it is. Being a psychopath works if you're a man. You can move from community to community, you can spread your genes widely by mating with a whole variety of people, and moving on. Unfortunately, the woman is left to look after the child, and that does tend to happen quite a lot. The same traits that lead to psychopathic personality behaviour in men may be present in women, but quite often they manifest differently, and women are less likely to be predatory, they're more likely to be self-harming than harming others, in fact, with similar traits.

David Rutledge: So what about examples - well, there's any number of them: Myra Hindley, Rosemary West, cases like this. Are these anomalous? I mean, would you call them psychopathic?

Stuart Kinner: That's a very good question. I mean, for example, Rosemary West is one I think of. I probably would, but not knowing enough about the case, I guess it's hard to be sure. She certainly exhibits some of the traits - the callousness, the lack of emotion - but again, the fact that she was basically supporting Fred West in his crimes, suggests that she wasn't really unreliable, manipulative and self-serving, in the way that the psychopath is.

Natasha Mitchell: So psychopathic people seem to inhabit a different moral universe. And the nature of morality is something that psychologist James Blair has been studying for many years now. So what light does his work with psychopaths shed on his ideas about how each of us develop a sense of morality?

James Blair: Well, the idea really is that in order to care about immoral behaviour, in order to be upset by the idea of hitting another human being, you've got to be effectively punished in your past by seeing the sadness of others. So what morality, or the development of morality, seems to be all about, is learning the badness of things that actually hurt others, and that we need these emotional systems in order to do that learning process. And if those emotional systems are damaged, there is impairment in your moral development.

Natasha Mitchell: The problem with psychopathy is that it's very hard to treat. Psychopaths, as we've heard today, don't respond to fear or sadness, and they don't experience guilt or remorse. So you've got to wonder: is punishing them by putting them in prison a waste of time? Here's Stuart Kinner.

Stuart Kinner: It's not a waste of time, but it is entirely ineffective. The research suggests that punishment is not at all effective with psychopaths, and in fact the only thing that is going to work is reward, judiciously handed out. Unfortunately we can't go round letting psychopaths commit their crimes and then just reward them when they start doing things right. The only things in the short term that do seem to be effective, are either indefinite incarceration, or trying something alternative with psychopaths. We also know that current treatments, for example, empathy training and anger control, are entirely ineffective with psychopaths. In fact, there's some research showing that treatment can have a negative effect. Teaching people to think more about other people's emotions, teaching them about empathy, teaching them to think about other people, is actually just increasing their ability to manipulate and con others.

David Rutledge: One really striking thing about psychopathy: when we talk about definitions, and we note that psychopaths don't experience sadness or fear or guilt, and they don't seem to inhabit a moral universe of any kind; in this they're almost model citizens of precisely the kind of society that many people are afraid is developing around us. We're always reading about how our culture, especially youth culture, is desensitised and emotionally detached and exploitative and sensation-seeking. Do you ever find yourself looking around and forming the professional opinion that Yes, this is in many respects a psychopathic world that we're living in?

Stuart Kinner: Not a psychopathic world. It is a world which is, at least the Western world, is increasingly endorsing some psychopathic traits. There are some that we will never endorse: parasitic lifestyle, for example, which is one of the diagnostic criteria for psychopathy. But you know, the charming, superficial interpersonal style, the lack of remorse and guilt, and shallow affect: things like that, I think, are being endorsed - in fact, even encouraged - in Western society to some extent. And I think that is a cause for some concern.

Natasha Mitchell: What an unsettling thought. Forensic psychologist Stuart Kinner there, from the University of Queensland, speaking with David Rutledge.

So back to the question of biology. In light of James Blair's research into a possible neurological basis of psychopathy, what then is the potential of a pharmaceutical option, a drug that works on a particular bit of the brain in these people, an anti-psychopathy pill of sorts?

James Blair: It's a possibility. I mean, the fact is there are other emotional disorders like anxiety and depression where indeed the treatment, if not targeting a bit of the brain, certainly has an effect on the areas of the brain that we know are associated with the problems of depression or anxiety, and you can see the impact of the treatment on the person's brain, and you obviously also see the impact of the treatment on their behaviour as well. I actually, yes, I'm reasonably optimistic that we may indeed be able to treat this emotional disorder, like those other emotional disorders, in potentially the not-too-distant future. Although you then have to do a lot of cognitive behavioural techniques in order to make sure they do form the right emotional links between offending behaviour and the victims. You couldn't just switch it on and everything would be OK.

Natasha Mitchell: Dr James Blair, from the Institute of Cognitive Neuroscience at University College, London.

But a final, and perhaps controversial, question is: do those psychopathic people who have committed horrendous crimes deserve rehabilitation? Forensic psychologist Stuart Kinner says Yes.

Stuart Kinner: The public, which includes myself, I think has a very understandable reaction to these crimes. But I think what we need to do, on the basis of what we know about these individuals, is educate the people about how best to reduce the incidence of their offending, not only by incarcerating them, but by preventing people who have psychopathic traits from ending up committing these crimes. Most importantly, I think in terms of developmental crime prevention, identifying these children who have psychopathic tendencies early, recognising that they're not born bad, but only with tendencies, and then helping them find asocial or even pro-social ways of meeting their needs, recognising that they may be thrill-seeking, that they need excitement and scary experiences, and providing them with those.

Natasha Mitchell: Stuart Kinner. And that's where, thankfully, we leave the world of the psychopath, for now at least.

Thanks to Jenny Parsonage and David Rutledge for their production prowess today. I'm Natasha Mitchell, catch you next week.

Guests

Dr James Blair

Senior Lecturer Insitute of Cognitive Neuroscience University College London